59 year old Male

History of Present Illness (HPI):

  • Morbidly obese patient: BMI = 61
  • Hx of COPD, possible obstructive sleep apnea, systemic hypertension, hyperlipidemia.
  • Presents with severe substernal chest pain.
  • ECG revealed sinus rhythm with ST elevations in leads 2, 3 and aVF, with QS complexes in same. ST depression noted in leads 1 and aVL.
  • Acute coronary syndrome diagnosed.
  • Emergency cardiac catheterization revealed:
    • Right Coronary Artery: 100% occlusion; dominant vessel.
    • Left Main: Normal.
    • Left Anterior Descending: 30% occlusion proximal portion.
    • Left Circumflex Artery: Normal.
    • Ramus Intermedus: 60% occlusion at origin.
    • Left Ventricle: 45-50% ejection fraction (EF).